Using two-way written narrative to unlock the anorexia prison

DE: What is Anorexia calling out to you at the moment, Helen? What is it saying to you as you struggle towards the Anti-Anorexic side? What is it calling out to you?

HW: Punish yourself! Starve yourself!

Writing was both a survival tool and a recovery tool during my incarceration with the eating disorder, anorexia nervosa. The illness had been embedded in my brain for more than 20 years when I met the psychiatrist who would save my life. I could hardly speak. He encouraged me to write to him instead. For years, I arrived for my next appointment with pages of hand written scrawl. The psychiatrist would read it all, and respond verbally. I would clutch his words to take home, inserting what I remembered in my diary. Gradually I found my voice, and escaped the eating disorder prison.

Reflecting, I believe that if the psychiatrist had engaged in two-way written conversation, my pace of recovery would have accelerated by years. A health professional with expertise in the narrative can probe more deeply, they can encourage the client to push under the layers, to shed light in the dark corners of the mind. They can learn more and collaborate more to help the client help their own recovery. When words are written, we see them as well as hear them. The power of the narrative is great, and benefits in a safe and supportive environment are many. For a start, the risk of misinterpretation is minimized. We can re-live the session in our own time when we arrive home. We can write and seek clarification if we are not sure we understand, or if we have a new line of thought to share. The narrative enables the level of healthy connection to go up and up. The bond between mind and body, crucial for recovery, is strengthened in multiple ways.

Narrative therapy works by separating people from their problems. Developed by David Epston and Michael White in the 1970s and 80s, narrative therapy is non-pathologizing, empowering, and collaborative. It recognizes people have skills and expertise that can help guide change in their lives.

The Diary Healer, an ardent supporter of narrative therapy, today shares a transcript that may be helpful for people struggling with anorexia or bulimia, their loved ones, and the practitioners who work with them. This particular text, recorded 25 years ago, is noteworthy because it is an example of an approach, known as Anti-Anorexia/Anti-Bulimia, developed to combat the suffering caused by anorexia/bulimia.

To set the scene: This is David’s fourth interview with Helen, aged 22, who had been hospitalized for the previous three years. Her parents’ bankruptcy as a consequence of her private hospital fees had necessitated her return to Auckland where she was facing a re-admission to the public health services. She never was re-admitted.

DE (David Epston, the narrative therapist): I am talking to ‘Helen’ on the 28th day of the fifth month of 1991. We were just talking briefly about Tracy ringing you.

I’ve just read your comment on my recent letter, that “all this has been mind-blowing”. Can you tell me how it’s blown your mind? How has that happened? Is your mind in bits?

HW (Helen, the patient): Yah…I don’t know where I am, you know.

DE: Are you with Anti-Anorexia? Or are you with Anorexia?

HW: Anti-Anorexia!

DE: Great! How do you think you turned against Anorexia because when I last met you, you were very much in the grip of Anorexia. Would that be fair?

HW: I still am.

DE: Are you moving away from IT?

HW: I hope so.

DE: Tell me where you have got to with your Anti-Anorexia? And what makes you think you are starting to separate from Anorexia because I can see you have your mind here? You’ve got your mind now? And I wasn’t so sure last time that you had your mind? I’m not saying that in a critical way. Tell me about the effect of my letter and your phone contact with Tracy…where has it blown your mind to? I know its blown it somewhere?

HW: I just feel I might be beginning.

DE: Great! Wow, is it exciting? I don’t want get too excited but boy, at least, you’ve got a beginning.

HW: Yah…

DE: Did you think you were coming to your end?

HW: Yep!

DE: Can you tell me about your beginning?

HW: I still feel it’s a new beginning…it’s just there but at the moment, I feel I am still at the end. Do you know what I mean?

DE: Do you think you’ve crossed the river over to the other side? What side are you on?

HW: I am struggling to cross it but the water’s cold (laughter)!

DE: Are you struggling towards the Anti-Anorexia side?

HW: Yah…it’s so hard!

DE: Do we need to call out to you to encourage you to come to our side?

HW: Yah because Anorexia will call me. And if no one is calling from the other side, it is easier to go the way you can hear someone calling.

DE: Do we need to be louder than Anorexia? What is Anorexia calling out to you at the moment, Helen? What is it saying to you as you struggle towards the Anti-Anorexic side? What is it calling out to you?

HW: Punish yourself! Starve yourself!

DE: Anything more than the usual stuff?

HW: Don’t listen to them!

DE: The Anti-Anorexic side?

HW: Yah and making excuses all the time.

DE: What excuses did it try on you?

HW: It tries to put things into my mind that will destroy me.

DE: What sort of thoughts is it intruding into your mind that are murderous?

HW: Mainly food-oriented and trying to have the least and wangle out of eating as much as you can. And also kind of cheating yourself.

DE: Why do you think Anorexia uses fatal ideas that have a lethal attraction?

HW: I don’t know!

DE: Why is it using these deadly ideas on you?

HW: To kill me!

DE: To kill you. Is this a new thought of yours to know that you are now facing up to your murderer?

HW: Yah!

DE: Before, did it try to embrace you in some loving way and tell you it was your friend?

HW: Yes…it’s just become part of me, you know.

DE: Do you have any sense, now that you are getting rid of it a bit, and seeing yourself take up more space for you, in your life?

HW: I’m hoping to.

DE: Well, right now as we are talking, what per cent do you think you are in your mind and what per cent do you think Anorexia is in your mind?

HW: I don’t know.

DE: Just take a guess (a long and thoughtful pause). Well, what do you think Anorexia would be thinking of the conversation we are having?

HW: Not very happy.

DE: What do you think about displeasing Anorexia?

HW: Well, I’ve got to do that as much as I can.

DE: Can you imagine what this tells me — that you can think Anti-Anorexic thoughts?

HW: Well, I’ve never been able to find a way of dealing with IT. Like the time before I just talked about what was happening.

DE: Before, you just talked through Anorexia in a sense?

HW: Yah…about her but not against her.

DE: That’s well put!

HW: No one has ever taught me that you have to be against HER. Before all I was told was that you just have to get over it. It’s more than that.

DE: Can I just go back to what you said before: people who worked with you just talked about Anorexia but you are talking AGAINST Anorexia?

HW: Yah.

DE: What’s different about the fact that you are talking AGAINST Anorexia than just with her? What does that mean for you?

HW: There’s more of a chance of getting free because I can start hating Her and when I do, I can let her go. I still find it so hard to connect eating with the Problem.

DE: Would you find it hard to connect the murdere(d)R with their knife?

HW: No.

DE: Is this starvation murder?

HW: Yah.

DE: That’s another way to murder a person. Can you understand that or am I putting ideas into your head? Does that make sense?

HW: Yah.

DE: (reading) What do you think of what Donna had to say there that through the fact of opposing Anorexia she became filled with anger at the “cruellest murderer” that she could think of- “self-starvation”? What does that fill you with?

HW: I am scared of her anger. I am really scared of anger.

DE: If you are scared of anger, how are you going to fight for your life? I am not saying you should have anger, but what do you want to fight with? There are other ways to fight. What about a cool sense of injustice? Do you want to fight with that?

HW: Am I strong enough?

DE: Look at Nelson Mandela. He was imprisoned for 28 years. Look at Ghandi. He was never known to have raised his voice. He brought Imperial Britain to its knees merely by his humanity. There are other ways and maybe they are more suitable to you.

HW: Yah.

DE: Do you think a cool sense of injustice is more suitable to you?

HW: Yah.

DE: And if you did develop a cool sense of injustice…a passionate sense of injustice…a strong sense of injustice and moral outrage, what would that be based on? Where would you get that from? What is unjust about your life?

HW: Because of my abuse.

DE: Are you starting to think about that in a slightly different way?

HW: I didn’t even know I was abused. I just thought it was my fault. And that’s what happens. And now I’m being punished for it. And this is what I deserve because I’ve been bad. IT’S MY FAULT!

DE: What made you change your mind on that?

HW: I haven’t!

DE: Do you think that will be the source of your injustice?

HW: I didn’t even know I had been abused until I went to the psychiatric hospital.

DE: How did they help you figure that out?

HW: I talked with them in my therapy and that and my doctor just said: “You’ve been abused!”

DE: Was that a big shock?

HW: Yah because I had never thought of it as abuse. I had known of other people who had been abused and I felt really bad that people had done that to them but for me, it was kind of different.

DE: How is it that you can sense that injustice perpetrated on them but injustice wasn’t perpetrated on you? Why can you have sympathy for them but not for yourself?

HW: They said I was a martyr.

DE: What do you think about that?

HW: I don’t know.

DE: Well if you could be a martyr for Anorexia, do you think you could be a martyr for Anti-Anorexia? Do you know how to become a martyr for Anti-Anorexia?

HW: How?

DE: YOU LIVE! Anti-Anorexia martyrs live on purpose. An Anorexia martyr dies on purpose. Can living be your cause? By the way, do you think you are becoming more devoted to your cause in general?

HW: Yah.

DE: What signs are you getting?

HW: I want more freedom!

DE: I sense that. Did you think in my letter I wanted freedom for you more than you wanted it for yourself?

HW: Yes.

DE: Was that upsetting for you? Should I drop back a bit?

HW: No! That encourages me to put thoughts into my own mind that might help me want freedom. Do you know what I mean? When people don’t tell you things, you don’t know.

DE: Do you think Anorexia has kept you in the dark?

HW: Yah!

DE: Has it cut you off other people’s thoughts and love for you?

HW: She’s made everything seem numb. NOTHING MATTERS. SHE HAS MADE ME FORGET EVERYTHING. She has put me in a regime…a concentration camp. I can’t feel anything. There are no feelings there. AND I AM YEARNING FOR THAT.

DE: Hey, when did you start yearning for that?

HW: Remember when you wrote that letter? It made me cry. And my Dad says: “Can’t you remember how much I love you?” (starts weeping inconsolably)

DE: Had Anorexia made you forget that? Can I ask then how much did he love you?

HW: Heaps! She (Anorexia) has taken that away (begins to cry once more).

DE: I think that’s awful! Do you think it could be helpful to you and your Anti-Anorexia to remember your father’s love? Can we talk about that because, when I met your Dad, I sensed a sadness in him that Anorexia had come between you. Can I ask you something? They are going to be hard questions so can you bear with them? If you get too tired of all the thinking just tell me and I will ask some easier questions. My questions will make your mind go back in time a bit. Is that okay? When you were a little girl and you were the apple of your father’s eye – because I know you were – what do you think he saw in you that Anorexia has blinded you to, so you can no longer feel his love?

HW: (wistfully) He just loved me.

DE: He loved you. What was so lovable about the you that he loved?

HW: I guess because we had a bond. And they always said I was a happy child. I was contented and placid. And I was good.

DE: If you saw yourself through your father’s loving eyes, what might you see in yourself when you get to the other side- Anti-Anorexia?

HW: He just wants me to have my life back. He wants me to be Helen again.

DE: Do you mind me asking who Helen was?

HW: I don’t know who Helen is. I don’t know.

DE: Would you be willing to dig up the old Helen? Is that okay? Maybe we are going to have to get your Dad to come so he can tell us who you were?

HW: Because I don’t know.

DE: Have you lost sight of Helen?

HW: I don’t even know who I’m meant to become, let alone know she was.

DE: Do you think the first Anti-Anorexic Project might be bringing the old Helen back to life?

HW: That would be okay because everyone said how nice she was. I thought I was the same but now I see I’m not.

DE: Do you think you are seeing yourself through your Torturer’s Eyes?

HW: Yes.

DE: I guess for IT to torture you, it must have to see you as a person who deserves torture; otherwise it wouldn’t be able to do its job very well? How are you going on tiredness (Helen looks weary)?

HW: I don’t want to go into hospital again because now I have an option. Before there was only HER OR NOTHING. I’ve got a choice now. I’ve just got to make the decision. Tracy said she had made that decision.

DE: Do you think you could have made that decision without the option being in front of you?

HW: No. HOW CAN YOU CHOOSE WHEN YOU HAVE ONLY ONE THING TO CHOOSE FROM. And you go for that, don’t you?

DE: Before you thought there was a choice between Anorexia and Nothingness?

HW: Yes! Between Anorexia and Anorexia (laughing out loud).

DE: That helps me understand the significance of Anti-Anorexia.

HW: I feel now if I keep on reading (the archives) and people keep affirming this, I can start thinking more about who I was. She (Anorexia) has made me forget all my memories. Even if I try to remember the green grass, that doesn’t mean anything. I can’t feel anything towards that. I think before I was so joyous and happy and loved life. All that I know at the moment is the CONCENTRATION CAMP in capital letters. This is just torture, torture, torture, 24 hours a day.

DE: I am glad that you are not being tortured here right now. I am glad this is a reprieve for you. Do you think reading the letters gives you a little space of freedom?

HW: Yah, it does.

DE: Good…good. Do you think listening to this tape might add some more time that you are free?

HW: Mmmh (perhaps savouring the thought of such freedom).

DE: Should we stop here for today?

HW: When shall we meet again?

Note: This transcript is from early in the 1990s and was recently recovered from the archives of the Anti-Anorexia League. It was the agreed that all documentation could be circulated pseudo-anonymously amongst League members. The letters Helen refers to are those of Tracy, available in the Chapter Nine, Ten Voices Against One: Tracy’s Story (pp.106-117) in Biting the Hand that Starves You: Inspiring Resistance to Anorexia/Bulimia (2004). Co-authored by David with Rick Maisel and Ali Borden, this book draws from the authors’ long collaboration with “insiders”, offering fresh answers to life and death questions such as: “How does a/b seduce and terrorize girls and women? Why is anorexia/bulimia successful in encouraging children and adults to unwittingly embrace their would-be murderer? How can such a murderer be exposed and thwarted?”

The Diary Healer will share more transcripts of therapist-client sessions in weeks to come.

Here are three more of David’s favorites:

A Polemics Of Life And Death by David Epston & Rick Maiselpublished in (2009), Malson, H. and Burns, M., Critical Feminist Approaches to Eating Dis/orders, London, Routledge.

Bearing Witness is based on the Plenary Address to the Australian & New Zealand Academy of Eating Disorders, Adelaide, October 20, 2006). This piece was published in Epston, D. (2008), Down Under and Up Over: Travels with Narrative Therapy, Warrington, United Kingdom; Association of Family Therapy (UK).

Unsuffering: “Are you ‘unsuffering’ your life through your thoughts and deeds? Should we introduce ‘unsuffer’ into the discourse of anti-anorexia/anti-bulimia (anti-a/b)? And the world at large? I am very intrigued by such a prospect…are you?” This conversation mostly occurred in 2007, between Julie King and David Epston.

The narrative therapy approach was an offshoot of Narrative Therapy (see White and Epston (1990), Narrative Means to Therapeutic Ends, Marsden, Epston and Markham (2016), and Narrative Therapy in Wonderland: Connecting with Children’s Imaginative Know-how). The best sources of information regarding anti-anorexia/anti-bulimia are the above-mentioned book, Biting the Hand that Starves You, and ‘Archives of Resistance: Anti-Anorexia/Anti-Bulimia’ at www.narrativeapproaches.com.

About Dr. David Epston

David Epston, together with Michael White (deceased), co-founded Narrative Therapy. David is co-director of the Family Therapy Centre in Auckland, New Zealand and Visiting Professor, School of Human Sciences and Community Studies, UNITEC Institute of Technology, Auckland. David did degrees at Universities of Auckland, British Columbia, Edinburgh and Warwick. He has an honorary D.Litt from John F. Kennedy University and awards for Distinguished Contributions to Family Therapy from the Australian and New Zealand Journal of Family Therapy (2002) and the American Family Therapy Academy (2007). In 1997, Dean Lobovits and Jennifer Freeman joined David to co-create the Archives of resistance: Anti-anorexia/Anti-bulimia, which disseminates hope and offers further readings, poems, and art for personal and professional use. The co-researchers of the League invented the terms and the transcript presented here is one such example. The term League derives from the collegial relationships between therapists and those who suffered and regained their ‘freedom’ to their lives and liberties.

The knowledge communicated on this website is for informational purposes only. June is not a therapist, doctor, dietitian, or mental healthcare practitioner, and therefore does not provide medical advice.